Cigarettes: shock, horror.

You may have noted the small flurry of articles this April in the early discovery period of the characteristics of Covid 19, mentioning that smokers had shown up as a disproportionately small fraction of hospitalised cases.

Several sets of figures have been recorded around the world. Initially for 480 positive patients at one Paris hospital of whom 350 ended up hospitalised around 5% were smokers. This compared to smoking rates of between 40% for the mainly released younger group down to 10% for the mainly hospitalised 65+ group. A wider observation was that of 11,000 people admitted in Paris hospitals, 8.5% were smokers against 24.5% of the population. (Guardian 22 April 2020). Later on some figures for for China where 13 studies showed 6.5% of Covid ‘patients’ were smokers and also for a US study of 7,000 people testing positive by CDC giving 1.3 being smokers against 14% of the whole population. (Daily Express 24 April 2020)

A number of the medical people asked to comment remarked how huge an effect this appeared to be statistically. The author of one French study, speaking of risks divded by 4 or 5 said “we rarely see this in medicine”. These were people used to acute clinical medicine where you don’t have to press too hard to get acknowledgement that the drugs used in routine practice might only achieve a small percentage survival rate at the risk of some fairly rapid and dramatic side-effects (kidney failure for example.) These chosen experts of the day, used to measured language, are in effect sayng the equivalent of ‘bloody amazing’.

For me it immediately brought to mind a former neighbour and dedicated roll-up smoker (in small quantities) who always referred to native American tobacco usage as having been not only ceremonial but health-protective when used, as it was, purposefully. She was a collector of obscure statistics of things that smokers died less often from – I can’t remember now exactly what the stories were. Certainly the tales justified her habit, but it never felt entirely devoid of reality to me.

It seemed intriguing following this how few people seemed to mention it in general conversation. Most of my friends these days are non-smokers (as have I been apart from 1 year in early life) so I don’t know if that bias was telling. Had people read it, or just found it uninteresting ? A global shock based on a virus that most of us think may kill us or a loved-one imminently, followed by evidence that a very common habit, until recently very fashionable, might have a 50-80% protective effect: met in general with a slightly confused shrug.

Turning to how this news was re-transmitted by political leaders. First point of note was the almost complete avoidance of mentioning tobacco smoking, but immediately an assumption that this effect must be from the presence of nicotine in the bloodstream, and hence that trials would be done on the use of nicotine patches. It seemed extraordinary to me that, for an infection whose main effect is in the lungs, where smoking delivers a nicely toxic mix of particulates and vapours, to jump to the conclusion that any inhibitive effect was of simply of the known pharmacological ingredient once it was in the bloodstream. (But then again I am no medical scientist.)

Secondly, not so very surprising for ‘normal times’ but for now an illustration of just how simplistic and ‘PC’ its necessary for even Tory leaders to be, every comment was prefaced by a statement of horror about the fatal danger of cigarettes. This seemed to me to be a massive and almost comical distortion of risk attitude.

I mean, we all know someone who smoked 40 a day for 30 years and ended up with something rather nasty. Often they were smoking commercially produced cigarettes with huge amounts of additives, and often smoking as a nervous habit, sometimes simultaneously with food or drink and other likely exacerbators. i.e a long way from native American smoking habits passing the ceremonial pipe of home-harvested tobacco leaves.

But in times when people are going into hospital with a 50%+ chance of not coming out, it might be worth putting aside the strange idea that something is ‘all bad’, even though only 50 years ago it was more or less essential for many, and instead consider if it may have some benefits in certain circumstances. These are the days of closing down whole economies to reduce the risks of overwhelming critical care wards with perhaps 0.5% of the population (worst case projections). These are also the days of giving emergency approval to clinical drugs that may have even fatal side effects, to try to save more people in intensive care wards.

It would not seem irrationally self-harming, then, to break out a bit of organic rolling tobacco a couple of times a day for a few months at this time, particularly if life places you in close proximity to higher risks of infection.

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Mark Conrad
By Mark Conrad

Mark Conrad

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